By: Grace Goracci, MD

Irritable bowel syndrome (IBS) is a chronic condition of the digestive tract. This has also been called “spastic bowel.” Most people experience stomach pain along with either diarrhea and /or constipation. When someone is medically evaluated to determine the cause of these complaints, no exact cause is found (i.e.: no infections are found in someone experiencing diarrhea).

IBS is the most common stomach problem seen by GI doctors. It is the second most common reason that people are absent from work (with the common cold being the first). There is no “cure” for IBS, but there are medications to help control the symptoms.

The hallmark of IBS is stomach pain. This pain is most often a cramp pain located in the left lower stomach area. However, the severity and location of the pain can be variable. The pain is usually worse with eating and/or during times of emotional stress. The pain is usually relieved after having a bowel movement (BM). Some women notice an association of the pain at certain times of their menstrual cycle. IBS is diagnosed twice as often in women as men.

People can experience a change from their normal pattern of bowel movements – either diarrhea and/or constipation. Diarrhea is frequent loose stools, usually occurring more than three times a day. Constipation is associated with hard/rabbit pellet-like BMs. This change in bowel habit is the second most common complaint associated the IBS. Any change in bowel habit in anyone over 40 years old should be evaluated with a colonoscopy.

Diarrhea associated the IBS typically occurs during the day time, most often early in the morning or after eating a meal. There is often a sense of urgency and the feeling of not being totally emptied out after the BM. Some people also see mucous with the BM. If the diarrhea occurs in the middle of the night, this is NOT due to IBS. Any blood seen with a BM, either with diarrhea or constipation (appearing as a red or black BM) is NOT due to IBS. You should speak to your doctor immediately.

Other complaints associated with IBS can include stomach bloating, gas, nausea, heartburn, trouble swallowing and feeling full after only eating several bites of food. Despite having these problems, people do not loose weight!

There is no single specific test to diagnose IBS. Other similar conditions must be ruled out with medical testing such as: thyroid abnormalities, diabetes, ulcers, celiac disease (gluten sensitivity), bowel infections, Crohn’s disease, ulcerative colitis, colon polyps and cancer (to name a few).

Although there is no “cure” for IBS, there are treatments available based on the type of complaints that someone is experiencing. Most of the available treatments focus on reducing the pain and making the bowels more regular. Many symptoms of IBS can be helped by avoiding foods that worsen the symptoms and by increasing the amount of fiber in your diet.

The exact cause of IBS is not known. However, there are several theories as to the cause:

1. One theory suggests that there are abnormal contractions in the muscles of the bowel (hence the name “spastic bowel”).

2. People who suffer anxiety and/or depression and/or are under a lot of stress are more likely to have IBS complaints. Stress is not believed to be the cause of IBS, however it is felt that stress does make IBS complaints worse. There have been studies that found that IBS is more common in people who have experienced physical, verbal or sexual abuse.

3. People with IBS commonly have food intolerances. One theory suggests that food allergy and/or sensitivities cause IBS. This is being studied closely.

Foods such as dairy foods (which contain lactose) and gas producing food (such as beans, broccoli, cauliflower, onion) cause symptoms similar to IBS. Some medications can also cause bowel symptoms similar to IBS (be sure to discuss this with your physician before stopping any medications).

4. Another theory suggests that IBS is caused by “hypersensitive muscles” in the stomach. Medicines that lower the pain threshold in the bowel can improve the abdominal pain.

Please remember that problems such as a change in your regular bowel pattern, having recurrent bowel movements (i.e. diarrhea) in the middle of the night, any blood coming from the bowel, stomach pain that prevents you from sleeping or wakes you up in the middle of the night, fever, chills or weight loss are NOT signs of IBS and should be investigated by a physician.

Dr. Goracci has moved her office to 10 Darwin Drive, Newark, DE (located off of Kirkwood Highway near Harmony Road) and is presently accepting new patients. For more information or to schedule an appointment, contact her office at 302-453-9171.

Publisher’s Note:

When I met with Dr. Grace for the paper the first thing that struck me was the fact that she had to be one of the most gentle, easy to talk with doctors that I had ever met. When I was a young person doctors like her were common, but today they are a rare find. I hope that she will never lose that touch of human concern that she displays.

Dr. Goracci has a GI practice located off of Kirkwood Highway in Newark, DE. She is an Attending at Christiana and Wilmington Hospitals. Before coming to Delaware, she spent 12 years in a group GI practice in Elmira, NY. Her practice in NY consisted of 90-95% female patients.

Dr. Goracci attended Jefferson Medical College and completed her Internal Medicine Residency at Thomas Jefferson University Hospital in Philadelphia. She completed her GI Fellowship at the Combined NIH-Georgetown-VA Program in Bethesda, MD.

Community involvement includes active participation and leadership roles in both Boy Scouts and Girl Scouts with her son and daughter. She has also served on several committees at her prior church in NY.